Contemporary patterns of treatment and outcomes in germ-cell tumors across a provincial cancer system: British Columbia Germ Cell Tumor Clinical Database.

Abstract

603 Background: British Columbia (BC) provides centralized, province-wide management for germ-cell tumors (GCT) across a large, dispersed population of >5 million. Longstanding electronic record and recent data integration enabled a comprehensive, population-based GCT database. We describe real-world treatment patterns and outcomes and its potential as a North American platform for collaborative studies. Methods: Adult type II GCT diagnosed in BC, 2002–2022, were identified from linked oncology registries and pharmacy databases. Survival follow-up was censored July 31, 2025; systemic therapy through Dec 31, 2023. Primary outcome: overall survival (OS) from diagnosis by histology. Secondary: OS from first-line (1L), time to next therapy (TTNT) from 1L, and chemotherapy-free survival (CFS) from orchiectomy. Treatment patterns (1L regimen, salvage, radiotherapy [RT], surgery) were summarized by histology and era (2002–08, 2009–15, 2016–22). Results: Among 2,366 patients (seminoma 65%, non-seminoma 35%), median age was 38 [IQR 31–46] and 30 [24–36] years. Curative-intent systemic therapy was given to 682 patients (29%). BEP led 1L regimen in all eras (non-seminoma 56.4%→85.0%→78.9%; seminoma 25.7%→68.4%→76.1%), while VIP rose after 2016 mainly in non-seminoma (9.0%→16.4%) and remained rare in seminoma (≤2.5%). Salvage chemotherapy occurred in 5.1% overall, chiefly TIP. RT decreased and was largely confined to seminoma (11.9% vs 2.5%; predominantly adjuvant); in non-seminoma it was largely palliative. Surgical management in non-seminoma was marked by RPLND (20.9%) and lung resections (4.7%). OS from diagnosis (3y/5y): seminoma 98.0/97.2%; non-seminoma 96.5/95.8%. OS from 1L: 95.4/94.7% (seminoma) vs 94.2/93.6% (non-seminoma). TTNT (1y/3y): 88.1/86.2% vs 87.1/84.4%. By era, 5y OS from diagnosis improved 96.2%→97.4%; 5y OS from 1L 90.5%→95.7%; 3y TTNT 83.1%→84.2%. CFS (1y/3y) after orchiectomy: 79.6/73.3% (seminoma) vs 59.2/55.2% (non-seminoma). Conclusions: Across two decades, outcomes for GCT in BC remain outstanding within a publicly funded, multidisciplinary hub-and-spoke system. Practice patterns reflect centralized, expert-guided care with low adjuvant use, BEP-dominant 1L regimens, and appropriate surgical consolidation in non-seminoma. The population-based BCGCT database with validated longitudinal data enables secondary analyses, data sharing, and linkage with emerging biobanks and datasets.